Photogrammetry was used to elucidate complex strata relationships between isolated outcrops of the Palaeocene lava fields of SW Mull, part of the North Atlantic Igneous Province. Subsequent sampling for lava geochemistry and palynology was undertaken based on interpretation of these photogrammetry models. Coherent units of Plateau- and Staffa-type lavas were identified using lava geochemistry, in particular using rare earth elements (REEs), divisions supported by multivariate statistics. Lavas with three different REE compositional clusters were identified within the Staffa magma type and four within the Plateau type of SW Mull. Understanding the distribution of these lava types was achieved using the interpreted photogrammetry models and analysis of prominent interbedded sedimentary rock units and their correlative unconformities. Probably the most renowned rocks of SW Mull are the thick columnar jointed lavas, including those of the Isle of Staffa. REE geochemistry reveals that lavas of both Staffa- and Plateau-type geochemistry occur as columnar jointed facies associated with what has previously been attributed to the Staffa Lava Formation. Instead, the SW Mull Lava Field was initiated by eruption of Plateau-type lava into a fault-controlled valley. Subsequent eruptions of Staffa-type lavas partially infilled this structure, which was finally overfilled by a thick succession of younger Plateau-type lavas. The geochemical characteristics of this Plateau–Staffa–Plateau lava succession indicate that magma reservoirs deep in the crust were succeeded by shallow melts during a period of crustal extension. This phase of shallow melting induced topographical instability and formation of sedimentary interbeds and correlative unconformities that characterise the Staffa-type lava succession. Subsequent compressive tectonics forced a return to deep crustal melts. Interbed palynofloral compositional data indicate that eruption of the later Plateau-type lavas likely took place within a period of ~2.5 million years during the Selandian to early Thanetian period.

The Jurassic to Cretaceous strata exposed in the Rollrock Section, Sverdrup Basin, Arctic Canada, represent one of the northernmost continuous outcrops spanning this poorly understood transition. The Oxfordian–Valanginian mudstones of the Rollrock Section were deposited in a shallow marine environment and, as such, provide the ideal lithology to investigate the response of high latitude dinoflagellate cyst populations to the frequent environmental perturbations of this time. Using a multivariate statistical approach, distinct palaeoecologically significant groups are identified and directly linked to time and palaeoenvironments, allowing for the reconstruction of underlying long term palaeoenvironmental trends. These palaeoenvironmental trends are identified to be driven by sequence stratigraphic cycles. For the first time, fourth order sequences are recorded from this pivotal period in the Sverdrup Basin and reveal an additional level of short term climatic events that complicate the identification of long term trends. The relationship existing between marine phytoplankton and climate is utilised to decipher the interplay of long-term and short-term climate fluctuations, distinguishing them from evolutionary trends. Two groups of dinoflagellate cysts, identified by process morphology, are recorded to act as environmental proxies. High percentages of proximochorate dinoflagellate cysts, such as Trichodinium erinaceoides, indicate more proximal, high energy, nutrient rich conditions and are dominant in fourth order transgressive systems tracts. High percentages of chorate dinoflagellate cysts, such as Oligosphaeridium complex, signify distal, low energy, nutrient depleted conditions and are dominant in fourth order highstand systems tracts.

The Paleogene lava flows of the Faroe Islands Basalt Group are divided into three relatively thick formations. The oldest, the Beinisvørð Formation is separated from the second lava flow succession, the Malinstindur Formation, by two formations composed primarily of volcaniclastic rocks. The oldest of these, the Prestfjall Formation has been interpreted as a period of eruptive quiescence and linked to changes in mantle melting. It is characterised in the south by the occurrence of coals, while the overlying Hvannhagi Formation is a sequence of primary and remobilised volcaniclastic strata. Field, laboratory, palynology, and photogrammetry studies have been used to investigate variations in facies and architecture within these volcaniclastic formations. The data reveal significantly different depositional systems in the Prestfjall and Hvannhagi formations over the ~40 km from the island of Vágar in the north to the island of Suðuroy in the south. Facies distribution in both the Prestfjall and Hvannhagi formations was found to have been controlled by a complex interaction of regional paleoslope, pre-existing topography, the eruption and local collapse of low-angle shield volcanoes, and minor brittle deformation. Lithological data and photogrammetry have enabled the identification of a > 180 m thick succession of volcaniclastic conglomerates deposited by lahars reworking a low-angle shield sector collapse. Co-occurrence of facies characteristic of the Prestfjall, Hvannhagi and Malinstindur formations indicate that volcanic eruption continued at a lower tempo throughout the Prestfjall Formation interval. Identification of a Beinisvørð Formation low-angle volcano shield northwest of the Faroe Islands alters the previous eruption model for this extensive lava field.

The integration of biostratigraphical, wireline log, geophysical and available geochronological ages has identified two principal periods of volcanism in the Faroe–Shetland and Rockall basins. The first is pre-breakup, upper Danian to lower Thanetian: in the Rockall and Faroe–Shetland basins, isolated volcanic activity from 62 Ma to 58.7 Ma is identified in areas closely linked to the SSW–NNE structural fabric of the continental margin. Volcanic activity was concentrated at basin flank fissures and localised point sources. This rift-flank volcanism led to widespread volcanic ash deposition, localised lava flow fields and the formation of igneous centres. Some of the Hebridean and onshore central complexes (e.g., Rum) were uplifted and rapidly eroded during the later pre-breakup period, while additional accommodation space was developed in the adjacent offshore basins. Onset and termination of pre-breakup volcanism is correlated to intra-plate stress regimes in Europe, following the cessation of convergence of Africa and Europe in the Danian. The second is syn-breakup, upper Thanetian to Ypresian, initiated at ca.57 Ma in the Rockall and Faroe–Shetland basins. Initial high-volume extrusive igneous successions were focussed to the W in the Faroe–Shetland Basin. In the centre and E of the Faroe–Shetland and Rockall basins, separate eruption loci developed along pre-existing lineaments either as fissure or point-sourced lava fields. Short-term cessation of eruption at ~55.8 Ma was followed by resumption of flood basalt eruptions and a shift in focus to the NW. Fluctuations in the syn-breakup eruption tempo are reflected in the formation and subsequent rejuvenation of prominent unconformities, only previously recognised as a single erosive event. The W and northward shift of eruption focus, and the eruption of mid ocean ridge basalt-type lavas in the syn-breakup period reflect the onset of lithospheric thinning in the nascent North Atlantic Rift prior to flooding of the rift and eruption of the widespread lower Ypresian Balder Formation tephras.

Dementia has been recognised as a major challenge to health, social care and economies. Research by Rubinsztein and colleagues, in this issue, has compared the services provided by memory clinics with those of traditional community mental health team services. They conclude that memory clinics offer a more comprehensive and multidisciplinary service at no extra cost. Here I will question some of their findings and highlight the importance of better continuity of care between primary and secondary services.

General hospitals and hospices see mostly older people, many of whom have dementia and multiple pathologies: delirium is common, costly and damaging. Informed and kindly care can reduce the incidence of delirium and hasten its resolution. O'Connell et al demand ownership of this phenomenon by the whole hospital. This will require a turnabout of philosophy, management and training for all professions.

Background: Substantial epidemiological research has shown that psychotic experiences are more common in densely populated areas. Many patients with persecutory delusions find it difficult to enter busy social urban settings. The stress and anxiety caused by being outside lead many patients to remain in-doors. We therefore developed a brief CBT intervention, based upon a formulation of the way urban environments cause stress and anxiety, to help patients with paranoid thoughts to feel less distressed when outside in busy streets. Aims: The aim was to pilot the new intervention for feasibility and acceptability and gather preliminary outcome data. Method: Fifteen patients with persecutory delusions in the context of a schizophrenia diagnosis took part. All patients first went outside to test their reactions, received the intervention, and then went outside again. Results: The intervention was considered useful by the patients. There was evidence that going outside after the intervention led to less paranoid responses than the initial exposure, but this was only statistically significant for levels of distress. Conclusions: Initial evidence was obtained that a brief CBT module specifically focused on helping patients with paranoia go outside is feasible, acceptable, and may have clinical benefits. However, it could not be determined from this small feasibility study that any observed improvements were due to the CBT intervention. Challenges in this area and future work required are outlined.

Background: The provision of mental health care for older people will become increasingly important with rising demand related to global demographic changes. This project aimed to identify changes in work patterns of UK consultant old age psychiatrists between 1993 and 2012.

Method: A link to an online questionnaire was circulated to consultant old age psychiatrists through the Faculty of Old Age Psychiatry, Royal College of Psychiatrists.

Results: In all 210 usable responses were received. On the survey day 71% of old age psychiatrists arrived at work before 9 am, and 40% left work after 6 pm. Over one-third (35%) worked for another hour or more at home. The range of activities was broader than previously reported. Administrative activity was undertaken by over 60% and acute ward work by only 26%. Few consultants reported time in long-stay care or day hospitals. Outpatient activity included Memory Clinics and Health Center Clinics. The main stressors reported by consultants were lack of resources and pressures from management-imposed, financially driven service changes. Relationships with people at work (including patients and their families) and outside work were the main identified support.

Conclusions: Consultants’ working hours have changed little since 1997, but the range and emphases of activities have changed. Changes in service organization are stressful and consultants are supported by relationships with colleagues and patients. Work patterns are changing in response to demands and constraints on the specialty. Research is needed into service design and work patterns, which can provide humane care in the current economic climate.

The Bridgend team rightly identifies the need for old age psychiatry services to work effectively with the population and staff of care homes. They describe an interesting and effective approach to this challenge, which will inform others and encourage them to make use of this system or adapt it or other ideas for use in their own locality.

That transfer of older people from one institution to another is detrimental to well-being, health and survival has been reported for 50 years. This has led to fear, anger and legal challenges when closures occur. Previous reviews identified accounts of relocation followed by adverse outcomes and others where problems were avoided or benefits claimed. This paper reviews the last twelve years of literature on health outcomes following involuntary relocation between nursing homes. Reports of post-move mortality, physical or psychological health suggest and confirm that relocation without preparation carries higher risk of poor outcomes than moves that are orderly and include preparation. The literature on the care home closure process, admissions and individual transfers offers insights into practices that might help minimize adverse outcomes. A number of agencies have produced helpful guidelines. How these are implemented needs to be monitored and linked to in-depth studies of sample closures.

Mental illness in old age is one of the most important healthcare issues of our times: if dementia were a country, it would be the world's 18th largest economy (Alzheimer's Disease International, 2010). In 1989, the UK Department of Health formally recognized old age psychiatry as a specialty in its own right, and by 2010 it had come of age. This anniversary was commemorated with a special edition of Old Age Psychiatrist, the newsletter of the Royal College of Psychiatrists, Faculty of Old Age Psychiatry (2011). To produce this, we called for “Janus” articles drawing on past experiences and giving thought to the future. Thirty-seven authors, ranging from students to retired colleagues, responded. Most contributors were UK-based but five worked elsewhere and provided an international perspective. The majority were psychiatrists who had devoted many years to the specialty, but their thoughts were set in context by representatives from other disciplines closely aligned to specialist healthcare services for mentally ill older people.

The General Medical Council's guidelines on treatment and care towards the end of life, published in May 2010, contain important guidance for all doctors, including psychiatrists, who care for patients and their families towards the end of life. The document is written in the light of the Mental Capacity Act 2005 and complements existing Good Medical Practice and confidentiality guidelines, also from the General Medical Council. Psychiatrists need to be aware of the communication, legal and ethical issues around end-of-life care, including advance directives and clinically assisted nutrition and hydration. This new guidance is compulsory reading for all psychiatrists.

The Royal College of Physicians' Palliative Care Services: Meeting the Needs of Patients and the Department of Health's End of Life Care Strategy are important reports that signify a national and international determination to address the needs of people who are nearing their time of dying, and their families, with positive, well-informed professionalism. Despite the advances of medicine and improved social conditions, death will eventually supervene. Psychiatrists and other mental health workers encounter death, in anticipation of its coming and in its aftermath. They need to be aware of developments in the field of end-of-life care and contribute to developments which are occurring, as well as learn and assimilate better practices.